Post-menopause Health Concerns

Ask the Raffles Medical Group Experts


I am 49 years old this year. I hope to understand more about ‘dry eyes’ and ‘dry virginal’ after menopause. Is it true that virginal dryness can be treated with Vagifem? Do you have any suggestions on how to improve irritation due to dry eyes?


During a woman’s lifetime, the ovaries are the main source of female hormone like Oestrogen, which control the development of female body characteristics such as the breasts, body shape, and body hair and keeps the skin youthful. The hormones like Oestrogen and Progestogens also regulate the menstrual cycle.

Unfortunately, menopause is the time in a woman’s life when the function of the ovaries slows down and then cease, thus the woman going through the period of time near the menopause experiences skin changes/dryness, mood swings, irritability and insomnia amongst other symptoms etc.

Vaginal dryness and eye dryness do occur but are less popular topics for discussion because these are not the most bothersome symptoms.

Vaginal dryness

Vaginal dryness and eye dryness usually occur several years after the menstrual cycle stops in the majority. However, some, especially women with dry skin, may experience it before the menopause. This is due to the lack of oestrogen.

Vagifem is an oestrogen vaginal tablet that is prescribed for women with the complaint of vaginal dryness. This is inserted into the vagina at night and as it dissolves into a liquid form, it coats the vagina skin and thus lubricates it. Thus the problem of vaginal dryness is alleviated.

There is also the premarin (oestrogen) cream, phyto-oestrogen creams, and non-hormonal creams, eg REPLENS in the market that can also alleviate the problem.

Dry eyes

Dry eyes are usually caused by a problem with the quality of the tear film that lubricates the eyes. Tears are formed by tiny glands that surround the eye and is comprised of three layers: oil, water, and mucous.

The mucus layer coats the cornea, the eye’s clear outer window, forming a foundation so the tear film can adhere to the eye. The middle aqueous layer provides moisture and supplies oxygen and other important nutrients to the cornea. This layer is made of 98 per cent water along with small amounts of salt, proteins and other compounds. The outer lipid layer is an oily film that seals the tear film on the eye and helps to prevent evaporation.

The tear film serves several purposes: it keeps the eye moist, creates a smooth surface for light to pass through the eye, nourishes the front of the eye, and provides protection from injury and infection.

When tears do not adequately lubricate the eye, a person may experience: pain, light sensitivity, a gritty sensation (ie a feeling of a foreign body or sand in the eye), itching, redness or even blurring of vision.

Sometimes, a person with a dry eye will have excess tears running down the cheeks, which may seem confusing. This happens when the eye is not getting enough lubrication. The eye sends a distress signal through the nervous system for more lubrication. In response, the eye is flooded with tears to try to compensate for the underlying dryness. However, these tears are mostly water and do not have the lubricating qualities or the rich composition of normal tears. They will wash debris away, but they will not coat the eye surface properly. In addition, because these emergency tears tend to arrive too late, the eye needs to regenerate and treatment is necessary.

There are many causes to dry eyes. One common reason for dryness is simply the normal aging process. As we grow older, our bodies produce less oil – 60 per cent less at age 65 then at age 18. This is more pronounced in women, who tend to have drier skin then men. The oil deficiency also affects the tear film. Without as much oil to seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea.

Many other factors, such as hot, dry or windy climates, high altitudes, air-conditioning and cigarette smoke also cause dry eyes. Many people also find their eyes become irritated when reading or working on a computer. Stopping periodically to rest and blink keeps the eyes more comfortable.